Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data

Abstract

The present systematic review critically examines the available scientific literature on risk factors for malnutrition in the older population (aged ≥65 y). A systematic search was conducted in MEDLINE, reviewing reference lists from 2000 until March 2015. The 2499 papers identified were subjected to inclusion criteria that evaluated the study quality according to items from validated guidelines. Only papers that provided information on a variable's effect on the development of malnutrition, which requires longitudinal data, were included. A total of 6 longitudinal studies met the inclusion criteria and were included in the systematic review. These studies reported the following significant risk factors for malnutrition: age (OR: 1.038; P = 0.045), frailty in institutionalized persons (β: 0.22; P = 0.036), excessive polypharmacy (β: -0.62; P = 0.001), general health decline including physical function (OR: 1.793; P = 0.008), Parkinson disease (OR: 2.450; P = 0.047), constipation (OR: 2.490; P = 0.015), poor (OR: 3.30; P value not given) or moderate (β: -0.27; P = 0.016) self-reported health status, cognitive decline (OR: 1.844; P = 0.001), dementia (OR: 2.139; P = 0.001), eating dependencies (OR: 2.257; P = 0.001), loss of interest in life (β: -0.58; P = 0.017), poor appetite (β: -1.52; P = 0.000), basal oral dysphagia (OR: 2.72; P = 0.010), signs of impaired efficacy of swallowing (OR: 2.73; P = 0.015), and institutionalization (β: -1.89; P < 0.001). These risk factors for malnutrition in older adults may be considered by health care professionals when developing new integrated assessment instruments to identify older adults' risk of malnutrition and to support the development of preventive and treatment strategies.

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission

“…In agreement with previous studies [26], malnutrition risk was associated with decline in cognitive status. Cognitive impairment is associated loss of independence which may negatively affect older adults’ lifestyle, specifically food intake and physical activity.…”

“…This may suggest loss of physical function among these participants which may contribute to the low muscle strength and high malnutrition risk observed. Previous studies reported that malnutrition risk is higher in older adults who rely on others for assistance with daily activities like grocery shopping and cooking [8, 14, 26]. Although not statistically significant ( p  = 0.061), our data demonstrated an increased risk of malnutrition among older adults who required help with ADL.…”

“…Medications and comorbidities are well documented factors associated with malnutrition [8, 26]. In the current study, on average each participant had six comorbidities and was taking seven medications.…”

“…individuals’ thoughts and feelings), and health status (e.g. functional ability, presence of comorbidities, polypharmacy, impaired chewing and swallowing) [26–30]. Understanding these factors may be helpful for identifying those at malnutrition risk and providing timely preventative interventions.…”

Socioeconomic Position and Malnutrition among Older Adults: Results from the FRADEA Study

“…There are many well-known risk factors for malnutrition in older people, including swallowing difficulties, early satiation, loss of appetite and multimorbidity (8,9). What is less clear is the association of SEP with malnutrition.…”